Provider Demographics
NPI:1770164410
Name:MCCLAIN, RAVEN LYNN
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:LYNN
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:EARLSBORO
Mailing Address - State:OK
Mailing Address - Zip Code:74840-8690
Mailing Address - Country:US
Mailing Address - Phone:405-658-6682
Mailing Address - Fax:
Practice Address - Street 1:223 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:EARLSBORO
Practice Address - State:OK
Practice Address - Zip Code:74840-8690
Practice Address - Country:US
Practice Address - Phone:405-658-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator